
<h1 class="s_title"><?php echo lang('billing_informations');?></h1>
            	<form action="<?php echo site_url('member/profile/billing-information');?>" method="post" name="billing_informartion">
                <div class="content_table" id="signup">
                	
                	{error_message}
                        <table width="100%" cellpadding="0" cellspacing="0" border="0">
	                        <tr valign="middle">
                                <td align="left"><label><?php echo lang("firstname");?>: <span class="red">*</span></label>
                                	<input name="b_firstname" value="{b_firstname}" type="text" class="input"/>
                                </td>
                                <td align="left"><label><?php echo lang("lastname");?>: <span class="red">*</span></label>
                                	<input name="b_lastname" value="{b_lastname}" type="text" class="input"/>
                                </td>                             
                            </tr>
                            <tr valign="middle">
                                <td align="left" colspan="2"><label><?php echo lang("company");?>: <span class="red">*</span></label>
                                	<input name="b_company" value="{b_company}" type="text" class="fullinput"/>
                                </td>                                                          
                            </tr>
                            <tr valign="middle">
                                <td align="left"><label><?php echo lang("phone");?>: <span class="red">*</span></label>
                                	<input name="b_phone" value="{b_phone}" type="text" class="input"/>
                                </td>
                                <td align="left"><label><?php echo lang("fax");?>: <span class="red">*</span></label>
                                	<input name="b_fax" value="{b_fax}" type="text" class="input"/>
                                </td>                             
                            </tr>
                            <tr valign="middle">
                                <td align="left" colspan="2"><label><?php echo lang("address");?>: <span class="red">*</span></label>
                                	<input name="b_address" value="{b_address}" type="text" class="fullinput"/>
                                </td>                                                          
                            </tr>
                            <tr valign="middle">
                                <td align="left"><label><?php echo lang("city");?>: <span class="red">*</span></label>
                                	<input name="b_city" value="{b_city}" type="text" class="input"/>
                                </td>
                                <td align="left"><label><?php echo lang("state");?>: <span class="red">*</span></label>
                                	<input name="b_state" value="{b_state}" type="text" class="input"/>
                                </td>                             
                            </tr>
                                                  
                            <tr valign="middle">
                                <td align="left"><label><?php echo lang("zipcode");?>: <span class="red">*</span></label>
                                	<input name="b_zipcode" value="{b_zipcode}" type="text" class="input"/>
                                </td>
                                <td align="left"><label><?php echo lang("country");?>: <span class="red">*</span></label>
                                	{ddlCountries}
                                </td>                             
                            </tr>
                            
                        </table>
                        
                       	                       
                        <p class="fltrt">
                        <button type="submit" class="button float-right" name="btnContinue" ><span><?php echo "&nbsp;&nbsp;&nbsp;" . lang("save"). "&nbsp;&nbsp;&nbsp;";?></span></button> 
                        </p>
                        
                    </div>
                  </form>  
                    
                    
                    
                    
                    
                    
                    
                    
                    
                    
                    




